Totally percutaneous versus surgical cut-down femoral artery access for elective bifurcated abdominal endovascular aneurysm repair

Gimzewska, Madelaine; Jackson, Alexander; Yeoh, Su Ern; Clarke, Mike

doi:10.1002/14651858.cd010185.pub3

Cited by 33 publications

(38 citation statements)

References 29 publications

(1 reference statement)

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“…Although surgical cut down access was historically thought to be the safer method, existing literature has conflicting results with some studies showing no difference in outcomes based on percutaneous or cut down access and others reporting better results with the percutaneous approach. [35][36][37] The estimated blood loss was higher in the OUS cohort, as could be expected from the higher percentage of surgical cut downs. However, the overall estimated blood loss in this trial (94.0 6 147.1 mL) is nearly one-third of what was reported for the previous generation system in the Valor II trial (277.0 6 468.8 mL) 2 and one-half of the 216 6 293 mL of another contemporary device.…”

Section: Discussionmentioning

confidence: 60%

Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial

Azizzadeh

Desai

Arko

et al. 2019

Journal of Vascular Surgery

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Objective: The Valiant Navion stent graft system (Medtronic, Santa Rosa, Calif) is a new iteration of a thoracic endograft for the treatment of descending thoracic aortic aneurysms. Herein, the 30-day primary safety and efficacy outcomes and secondary end points are presented. Methods:The Valiant EVO global clinical trial is a prospective, nonrandomized, single-arm trial. Patient enrollment occurred from April 2016 to October 2017. The primary end point was defined as access and/or deployment failure and/or a major device effect (MDE), including device-related secondary procedures, device-related mortality, conversion to open surgery, or thoracic aortic aneurysm rupture within 30 days of the index procedure. Other measures of stent graft performance including procedural data, rates of secondary procedures, and frequency of endoleaks are also reported.Results: Of the 87 consecutive patients undergoing thoracic endovascular aneurysm repair who were enrolled, 33 (37.9%) were female with 61 (70.9%) presenting with severe access artery tortuosity and 66 (85.7%) with high thoracic aortic tortuosity per core laboratory evaluation. The mean procedure duration was 88.7 6 53.4 minutes and geographical differences existed such as percutaneous access (37/52 [71.2%]) in the United States and surgical cut down in the outside of the U.S. sites (28/35 [80.0%]). There were no access or deployment failures and only 2.3% of the patients (2/87; P < .0001; performance goal of 16%) experienced a MDE within 30 days of the index procedure. Two secondary procedures (n ¼ 1 retrograde type A dissection; n ¼ 1 aortic arch rupture) were required, and in the first 30 days, two patients died leading to a freedom from all-cause mortality of 97.7%. Endoleaks at 1 month were reported in 2.5% of patients (n ¼ 1 type Ia; n ¼ 1 type II).Conclusions: Access/deployment failures, MDEs, and endoleaks were rare in the first 30 days of the Valiant Evo clinical trial. The Valiant Navion thoracic stent graft system has shown encouraging 30-day results in this challenging cohort and trial patients will continue to be followed through 5 years. (J Vasc Surg 2019;70:1399-408.)

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Section: Discussionmentioning

confidence: 60%

Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial

Azizzadeh

Desai

Arko

et al. 2019

Journal of Vascular Surgery

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“…The cut-down method allows for complete visualisation of the femoral vessels, but takes longer and is associated with groin wound complications as seen following endovascular aortic aneurysm repair, the percutaneous approach for endovascular access is now favoured in most cases. [30][31] This study is limited by the use of cadaveric specimens which assume a 'fixed' anatomical position after embalming and were free from trauma that would have otherwise distorted the anatomy. It is conceivable that within the context of multisystem trauma whereby injuries are sustained to the trunk and lower limbs simultaneously, a blind landmark-based technique such as the one proposed may be less effective.…”

Section: Discussionmentioning

confidence: 99%

The REBOA window: a cadaveric study delineating the optimum site for austere cannulation of the femoral artery for resuscitative endovascular balloon occlusion of the aorta

et al. 2020

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IntroductionHaemorrhage is the major cause of early mortality following traumatic injury. Patients suffering from non-compressible torso haemorrhage are more likely to suffer early death. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) can be effective in initial resuscitation; however, establishing swift arterial access is challenging, particularly in a severe shock. This is made more difficult by anatomical variability of the femoral vessels.MethodsThe femoral vessels were characterised in 81 cadaveric lower limbs, measuring specifically the distance from the inferior border of the inguinal ligament to the distal part of the origin of the profunda femoris artery (PFA), and from the distal part of the origin of the PFA to where the femoral vein lies posterior to and is completely overlapped by the femoral artery.ResultsThe femoral vein lay deep to the femoral artery at a mean distance of 105 mm from the inferior border of the inguinal ligament. The PFA arose from the femoral artery at a mean distance of 51.1 mm from the inguinal ligament. From the results, it is predicted that the PFA originates from the common femoral artery approximately 24 mm from the inguinal ligament, and the femoral vein is completely overlapped by the femoral artery by 67.7 mm distal from the inguinal ligament, in 95% of subjects.ConclusionsBased on the results, proposed is an ‘optimal access window’ of up to 24 mm inferior to the inguinal ligament for common femoral arterial catheterisation for pre-hospital REBOA, or more simply within one finger breadth.

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“…Perclose sutures are secured, and heparin is administered to maintain an activated clotting time > 250 s. If the common femoral is not suitable for access, the superficial femoral artery may be used in selected cases with a large‐caliber vessel . When percutaneous access is not feasible, femoral or iliac artery surgical exposure is a safe alternative …”

Section: Endovascular Aneurysm Repair Techniquesmentioning

confidence: 99%

“…16 When percutaneous access is not feasible, femoral or iliac artery surgical exposure is a safe alternative. 17,18 Figure 3 demonstrates the sequence of endograft deployment.…”

Section: Procedural Techniquementioning

confidence: 99%

Percutaneous endovascular abdominal aneurysm repair: State‐of‐the art

Jabbar

Chanda

White

et al. 2019

Cathet Cardio Intervent

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Endovascular repair of abdominal aortic aneurysms emerged initially as an alternative treatment strategy for patients considered to be inoperable or high risk for surgery. The evolution of endovascular techniques has made this technology a safe and less invasive alternative to open surgery for patients with suitable aortic anatomy. This manuscript reviews the current state of the art for endovascular AAA repair techniques, clinical outcomes, guideline recommendations, and future applications.

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Totally percutaneous versus surgical cut-down femoral artery access for elective bifurcated abdominal endovascular aneurysm repair

Abstract: Totally percutaneous versus surgical cut-down femoral artery access for elective bifurcated abdominal endovascular aneurysm repair.

Cited by 33 publications

References 29 publications

Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial

Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial

The REBOA window: a cadaveric study delineating the optimum site for austere cannulation of the femoral artery for resuscitative endovascular balloon occlusion of the aorta

Percutaneous endovascular abdominal aneurysm repair: State‐of‐the art

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